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Cushing's Disease in Horses — Understanding the Whole Picture

If your horse has been diagnosed with PPID — Pituitary Pars Intermedia Dysfunction, commonly known as Cushing's disease — you have probably been given a prescription for Prascend (pergolide) and told to manage accordingly.

Medication has its place. For horses with confirmed PPID, pergolide can make a significant difference to quality of life.

But medication manages the condition. It does not address the cellular environment in which the condition developed, or create the conditions in which the horse's body can function as well as possible despite the diagnosis.

That is where the holistic approach comes in.

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What PPID Actually Is

The pituitary gland — a small structure at the base of the brain — is responsible for producing and regulating a range of hormones that control multiple body systems. In PPID, a specific part of the pituitary (the pars intermedia) develops adenoma-like changes that cause it to over-produce a hormone called POMC, which breaks down into multiple active compounds including ACTH.

Chronically elevated ACTH drives the adrenal glands to produce excess cortisol — the primary stress hormone. It is this cortisol overproduction that creates most of the clinical signs of PPID.

The classic signs:

• A long, curly coat that does not shed properly (hypertrichosis) — often the most visible early sign

• Muscle wasting, particularly along the topline

• Weight changes — often fat deposits in unusual locations alongside muscle loss

• Increased drinking and urinating (polyuria/polydipsia)

• Lethargy and reduced performance

• Increased susceptibility to infections and slow wound healing

• Laminitis — directly related to the insulin dysregulation that PPID drives

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The PPID-Laminitis Connection

This cannot be overstated.

PPID drives insulin dysregulation through the same pathways as EMS — chronically elevated cortisol disrupts insulin signalling, creates insulin resistance, and produces the elevated insulin levels that directly trigger endocrinopathic laminitis.

A horse with PPID has a significantly elevated laminitis risk — and that risk must be managed proactively, not reactively.

This means everything discussed in the laminitis and EMS blog articles applies with equal force to the PPID horse: forage management, gut health support, reduction of systemic inflammation.

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What Holistic Support Looks Like for the PPID Horse

Nutritional management: The PPID horse requires the same careful forage management as the EMS horse — , careful management of grass access. Because PPID often coexists with EMS, the metabolic dietary picture applies fully. Carefully means not small rations so that they run out of hay. It means high-quality feed, no wrap (plastic-packed haylage), and little or no grass during the difficult phase until the body has recoevered from the worst phase.

Antioxidant support: PPID is associated with oxidative stress — an imbalance between free radical production and the body's antioxidant defences. Targeted antioxidant support — Vitamin E, Vitamin C, selenium — provides meaningful support to the cellular environment.

Immune support: The suppressed immune function of the PPID horse means increased vulnerability to infections, slower healing, and reduced resilience. Immune-supporting nutrition and targeted supplementation are an important part of the holistic picture.

Gut health: Chronically elevated cortisol directly disrupts gut health — reducing gut motility, increasing gut permeability, altering the microbiome. Active gut support is particularly important in the PPID horse.

ASEA — cellular support: The cellular signalling disruption in PPID is profound. ASEA's support for cellular communication and repair processes is particularly relevant for a condition that is fundamentally about disrupted cellular regulation at the hormonal level.

Quality of life and stress reduction: The PPID horse is already dealing with elevated cortisol from the condition itself. Every additional stress in the environment adds to a cortisol load that is already high. Creating a calm, predictable, low-stress environment is not optional for the PPID horse — it is part of the treatment.

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The Horse Behind the Diagnosis

One thing I want every owner of a PPID horse to hear:

Your horse is not their diagnosis.

A PPID diagnosis is a description of a hormonal condition. It is not a verdict on what is possible, on what quality of life is achievable, or on how many good years lie ahead.

I have worked with horses in their late teens and early twenties with PPID diagnoses whose quality of life — when the full picture was addressed — was genuinely good. Not just adequate. Good. Horses that were comfortable, engaged, present, and loved.

The diagnosis shapes what we need to manage. It does not determine the ceiling.

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→ The Overweight Horse — includes the complete PPID and EMS nutritional management framework

→ The Ultimate Feeding Plan — the nutritional foundation tailored to the metabolically sensitive horse

→ Homemade Horse Treats — nutritional natural healthy treats

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